Echocardiographic Assessment And Comparison Of Outcomes Of Tricuspid Annuloplasty With Flexible Versus 3D-rigid Prosthetic Ring

Purpose:The present study compare the outcomes of tricuspid annuloplasty with flexible versus 3D-rigid prosthetic ring by echocardiography for functional tricuspid regurgitation to investigate whether there is any difference in outcomes between them.Methods:We collected the clinical and echocardiographic data of 76 patients who underwent tricuspid ring annuloplasty for functional tricuspid regurgitation from October 2015 to October 2016 in our hospital.The flexible band was used in 46 patients(flexible group),and the 3D rigid ring was used in 30 patients(rigid group).Echocardiographic evaluation of tricuspid and right ventricular function was performed preoperatively and postoperatively.Clinical and echocardiographic follow-up data of study patients were collected regularly and entered into the database.Patient hospital records and our cardiac surgery database were reviewed for the following: age at index surgery,sex,body weight,height,type of surgery,and history of prior cardiac surgery.Comprehensive 2-dimensional and Doppler echocardiographic examinations were performed preoperatively,1 weak and 1 year postoperatively,in a standard manner using commercially available echocardiographic devices.Preoperative echocardiography was obtained within one weeks before surgery.Tricuspid valve morphology can be evaluated by 2-dimensional transthoracic echocardiography from the standard parasternal and apical RV views: right ventricle inflow,parasternal short-axis,apical four-chamber and subcostal views.It is important to use all available views in 2-dimensional,colour and Doppler modes to obtain a complete evaluation of the valve by 2-dimensional transthoracic echocardiography,and to rule out and not underestimate a flail leaflet or a localized abnormality.The presence of tricuspid regurgitation and its severity were assessed using multiple transthoracic windows.The maximal tricuspid regurgitation jet area in any echocardiographic view was used to semi-quantitatively estimate tricuspid regurgitation grade using a standard color Doppler technique.Maximal tricuspid regurgitation jet velocity was obtained by continuous-wave.The parameters to be performed and reported also should include a measure of right ventricular size,right atrial size,tricuspid annular size,systolic function(at least one of the following: fractional area change,tricuspid lateral annular systolic velocity,and tricuspid annular plane systolic excursion,and systolic pulmonary artery pressure with estimate of right atrial pressure on the basis of inferior vena cava size and collapse.Estimated right ventricular systolic pressure was measured from the tricuspid regurgitation jet velocity.Results:1.As compared with preoperative conditions,flexible group and rigid group have significantly lower postoperative tricuspid regurgitation,right ventricular size,right atrial size(P < 0.05)and higher right ventricular fractional area change(P<0.05).2.Flexible group have more postoperative tricuspid regurgitation than rigid one 1 year postoperatively(P<0.05).3.Rigid group have higher right ventricular fractional area change than flexible one 1 year postoperatively(P<0.05)Conculsions:1.Echocardiography can effectively assess the outcomes of tricuspid annuloplasty.2.Tricuspid valve annuloplasty using flexible band or 3D rigid ring is associated with decreased postoperative tricuspid regurgitation and improved right ventricular function in comparison to preoperative conditions.3.Tricuspid valve annuloplasty using 3D rigid ring has lower tricuspid regurgitation than flexible band,while using flexible band has higher improved right ventricular function.